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SummaryThe term 'neglected tropical diseases' (NTDs) points to the need for a biosocial perspective. Although 'diseases' are widely understood as biological phenomena, 'neglect' is inherently social. Social priorities, social relations and social behaviour profoundly influence the design, implementation and evaluation of control programmes. Yet, these dimensions of neglect are, themselves, neglected. Instead, emphasis is being placed on preventive chemotherapy – a technical, context-free approach which relies almost entirely on the mass distribution of drugs, at regular intervals, to populations living in endemic areas. This article reflects on the processes which have enabled an NTD 'brand' identity to emerge, and it comments on a disquieting disengagement with some of the more critical insights about the consequences of mass drug administration. Building on the work of biosocial scholars studying other aspects of health and disease, a more adequate, evidence-based approach is delineated. Developing such an approach is an iterative process, requiring on-going engagement with both biological and social insights as they emerge. Considerable theoretical, methodological and political challenges lie ahead, but it is essential they are overcome, if the sustainable control of NTDs is to become a reality.

The term 'neglected tropical diseases' (NTDs) points to the need for a biosocial perspective. Although 'diseases' are widely understood as biological phenomena, 'neglect' is inherently social. Social priorities, social relations and social behaviour profoundly influence the design, implementation and evaluation of control programmes. Yet, these dimensions of neglect are, themselves, neglected. Instead, emphasis is being placed on preventive chemotherapy – a technical, context-free approach which relies almost entirely on the mass distribution of drugs, at regular intervals, to populations living in endemic areas. This article reflects on the processes which have enabled an NTD 'brand' identity to emerge, and it comments on a disquieting disengagement with some of the more critical insights about the consequences of mass drug administration. Building on the work of biosocial scholars studying other aspects of health and disease, a more adequate, evidence-based approach is delineated. Developing such an approach is an iterative process, requiring on-going engagement with both biological and social insights as they emerge. Considerable theoretical, methodological and political challenges lie ahead, but it is essential they are overcome, if the sustainable control of NTDs is to become a reality.

Abstract Schistosomiasis is a poverty-related parasitic infection, leading to chronic ill-health. For more than a century, schistosomiasis has been known to be endemic in certain provinces of the Democratic Republic of Congo (DRC). However, a clear overview on the status of the disease within the country is currently lacking, which is seriously hampering control. Here, we review the available information on schistosomiasis in DRC of the past 60 years. Findings and data gaps are discussed in the perspective of upcoming control activities. An electronic literature search via PubMed complemented by manual search of non-peer-reviewed articles was conducted up to January 2015. The search concerned all relevant records related to schistosomiasis in the DRC from January 1955 onwards. A total of 155 records were found, of which 30 met the inclusion criteria. Results were summarized by geographical region, mapped, and compared with those reported sixty years ago. The available data reported schistosomiasis in some areas located in 10 of the 11 provinces of DRC. Three species of Schistosoma were found: S. mansoni , S. haematobium and S. intercalatum . The prevalence of schistosomiasis varied greatly between regions and between villages, with high values of up to 95 % observed in some communities. The overall trend over 60 years points to the spread of schistosomiasis to formerly non-endemic areas. The prevalence of schistosomiasis has increased in rural endemic areas and decreased in urban/peri-urban endemic areas of Kinshasa. Hepatosplenomegaly, urinary tract lesions and anaemia were commonly reported in schistosomiasis endemic areas but not always associated with infection status. The present review confirms that schistosomiasis is still endemic in DRC. However, available data are scattered across time and space and studies lack methodological uniformity, hampering a reliable estimation of the current status of schistosomiasis in DRC. There is a clear need for updated prevalence data and well-designed studies on the epidemiology and transmission of schistosomiasis in DRC. This will aid the national control program to adequately design and implement strategies for sustainable and comprehensive control of schistosomiasis throughout the country.

Schistosomiasis is a poverty-related parasitic infection, leading to chronic ill-health. For more than a century, schistosomiasis has been known to be endemic in certain provinces of the Democratic Republic of Congo (DRC). However, a clear overview on the status of the disease within the country is currently lacking, which is seriously hampering control. Here, we review the available information on schistosomiasis in DRC of the past 60 years. Findings and data gaps are discussed in the perspective of upcoming control activities.An electronic literature search via PubMed complemented by manual search of non-peer-reviewed articles was conducted up to January 2015. The search concerned all relevant records related to schistosomiasis in the DRC from January 1955 onwards. A total of 155 records were found, of which 30 met the inclusion criteria. Results were summarized by geographical region, mapped, and compared with those reported sixty years ago. The available data reported schistosomiasis in some areas located in 10 of the 11 provinces of DRC. Three species of Schistosoma were found: S. mansoni, S. haematobium and S. intercalatum. The prevalence of schistosomiasis varied greatly between regions and between villages, with high values of up to 95 % observed in some communities. The overall trend over 60 years points to the spread of schistosomiasis to formerly non-endemic areas. The prevalence of schistosomiasis has increased in rural endemic areas and decreased in urban/peri-urban endemic areas of Kinshasa. Hepatosplenomegaly, urinary tract lesions and anaemia were commonly reported in schistosomiasis endemic areas but not always associated with infection status.The present review confirms that schistosomiasis is still endemic in DRC. However, available data are scattered across time and space and studies lack methodological uniformity, hampering a reliable estimation of the current status of schistosomiasis in DRC. There is a clear need for updated prevalence data and well-designed studies on the epidemiology and transmission of schistosomiasis in DRC. This will aid the national control program to adequately design and implement strategies for sustainable and comprehensive control of schistosomiasis throughout the country.

Schistosomiasis is a poverty-related parasitic infection, leading to chronic ill-health. For more than a century, schistosomiasis has been known to be endemic in certain provinces of the Democratic Republic of Congo (DRC). However, a clear overview on the status of the disease within the country is currently lacking, which is seriously hampering control. Here, we review the available information on schistosomiasis in DRC of the past 60 years. Findings and data gaps are discussed in the perspective of upcoming control activities.An electronic literature search via PubMed complemented by manual search of non-peer-reviewed articles was conducted up to January 2015. The search concerned all relevant records related to schistosomiasis in the DRC from January 1955 onwards. A total of 155 records were found, of which 30 met the inclusion criteria. Results were summarized by geographical region, mapped, and compared with those reported sixty years ago. The available data reported schistosomiasis in some areas located in 10 of the 11 provinces of DRC. Three species of Schistosoma were found: S. mansoni, S. haematobium and S. intercalatum. The prevalence of schistosomiasis varied greatly between regions and between villages, with high values of up to 95 % observed in some communities. The overall trend over 60 years points to the spread of schistosomiasis to formerly non-endemic areas. The prevalence of schistosomiasis has increased in rural endemic areas and decreased in urban/peri-urban endemic areas of Kinshasa. Hepatosplenomegaly, urinary tract lesions and anaemia were commonly reported in schistosomiasis endemic areas but not always associated with infection status.The present review confirms that schistosomiasis is still endemic in DRC. However, available data are scattered across time and space and studies lack methodological uniformity, hampering a reliable estimation of the current status of schistosomiasis in DRC. There is a clear need for updated prevalence data and well-designed studies on the epidemiology and transmission of schistosomiasis in DRC. This will aid the national control program to adequately design and implement strategies for sustainable and comprehensive control of schistosomiasis throughout the country.

Background: Taenia solium, a zoonotic parasite that is endemic in most developing countries where pork is consumed, is recognised as the main cause of acquired epilepsy in these regions. T. solium has been reported in almost all of the neighboring countries of Democratic Republic of Congo (DRC) but data on the current prevalence of the disease in the country itself are lacking. This study, focusing on porcine cysticercosis (CC), makes part of a first initiative to assess whether cysticercosis is indeed actually present in DRC. Methods: An epidemiological study on porcine CC was conducted (1) on urban markets of Kinshasa where pork is sold and (2) in villages in Bas-Congo province where pigs are traditionally reared. Tongue inspection and ELISA for the detection of circulating antigen of the larval stage of T. solium were used to assess the prevalence of active CC in both study sites. Findings: The overall prevalence of pigs with active cysticercosis did not significantly differ between the market and the village study sites (38.8 [CI95%: 34-43] versus 41.2% [CI95%: 33-49], respectively). However, tongue cysticercosis was only found in the village study site together with a significantly higher intensity of infection (detected by ELISA). Interpretation: Pigs reared at village level are sold for consumption on Kinshasa markets, but it seems that highly infected animals are excluded at a certain level in the pig trade chain. Indeed, preliminary informal surveys on common practices conducted in parallel revealed that pig farmers and/or buyers select the low infected animals and exclude those who are positive by tongue inspection at village level. This study provides the only recent evidence of CC presence in DRC and gives the first estimates to fill an important gap on the African taeniasis/cysticercosis distribution map.

Background: Taenia solium, a zoonotic parasite that is endemic in most developing countries where pork is consumed, is recognised as the main cause of acquired epilepsy in these regions. T. solium has been reported in almost all of the neighboring countries of Democratic Republic of Congo (DRC) but data on the current prevalence of the disease in the country itself are lacking. This study, focusing on porcine cysticercosis (CC), makes part of a first initiative to assess whether cysticercosis is indeed actually present in DRC. Methods: An epidemiological study on porcine CC was conducted (1) on urban markets of Kinshasa where pork is sold and (2) in villages in Bas-Congo province where pigs are traditionally reared. Tongue inspection and ELISA for the detection of circulating antigen of the larval stage of T. solium were used to assess the prevalence of active CC in both study sites. Findings: The overall prevalence of pigs with active cysticercosis did not significantly differ between the market and the village study sites (38.8 [CI95%: 34-43] versus 41.2% [CI95%: 33-49], respectively). However, tongue cysticercosis was only found in the village study site together with a significantly higher intensity of infection (detected by ELISA). Interpretation: Pigs reared at village level are sold for consumption on Kinshasa markets, but it seems that highly infected animals are excluded at a certain level in the pig trade chain. Indeed, preliminary informal surveys on common practices conducted in parallel revealed that pig farmers and/or buyers select the low infected animals and exclude those who are positive by tongue inspection at village level. This study provides the only recent evidence of CC presence in DRC and gives the first estimates to fill an important gap on the African taeniasis/cysticercosis distribution map.

•We assessed patterns of taeniasis in 24 village communities of Kimpese health zone.•Prevalence of taeniasis was very high and varied between households and villages.•Children of five to ten years were the most infected age group.•Taeniasis was not spatially correlated with porcine cysticercosis.

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. CONCLUSION: 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.

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. CONCLUSION: 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.

BACKGROUND: Clinical observations and animal studies have suggested that Salmonella intestinal carriage is promoted by concurrent Schistosoma infection. The present study assessed association of Salmonella intestinal carriage and Schistosoma mansoni infection among individuals in a Schistosoma endemic area in sub-Saharan Africa. METHODS: From November 2015 to March 2016, a cross-sectional community-wide study was conducted in Kifua II, a rural village in Kongo Central Province, Democratic Republic of Congo. Stool samples were collected and analyzed for Salmonella intestinal carriage (culture) and Schistosoma mansoni infection (Kato Katz microscopy with determination of egg load). Salmonella Typhimurium and Enteritidis isolates were assessed for genetic similarity with blood culture isolates obtained during the same period in a neighboring hospital using multi-locus variable-numbers tandem repeat analysis (MLVA). RESULTS: A total of 1,108 participants were included (median age 15 years (IQR: 7-36), male-to-female ratio of 1:1.1). The overall prevalence of Schistosoma mansoni infection and non-typhoidal Salmonella carriage was 51.2% (95% CI: 48.2-54.1) and 3.4% (95% CI: 2.5-4.7) respectively, with 2.2% (95% CI: 1.5-3.2) of participants coinfected. The proportion of Salmonella carriage tended to be higher among Schistosoma mansoni infected participants compared to non-infected participants but this difference did not reach statistical significance (4.2% versus 2.6%, p = 0.132). However, the proportion of Salmonella carriage among participants with a heavy Schistosoma mansoni infection was significantly higher compared to those with a light and moderate infection (8.7% versus 3.2%, p = 0.012) and compared to Schistosoma mansoni negatives (8.7% versus 2.6%, p = 0.002). The 38 Salmonella isolates comprised five and four Enteritidis and Typhimurium serotypes respectively, the majority of them had MLVA types identical or similar to those observed among blood culture isolates. CONCLUSION: Salmonella intestinal carriage was associated with a heavy intensity of Schistosoma mansoni infection. Further studies are needed to address causation.

BACKGROUND: Clinical observations and animal studies have suggested that Salmonella intestinal carriage is promoted by concurrent Schistosoma infection. The present study assessed association of Salmonella intestinal carriage and Schistosoma mansoni infection among individuals in a Schistosoma endemic area in sub-Saharan Africa. METHODS: From November 2015 to March 2016, a cross-sectional community-wide study was conducted in Kifua II, a rural village in Kongo Central Province, Democratic Republic of Congo. Stool samples were collected and analyzed for Salmonella intestinal carriage (culture) and Schistosoma mansoni infection (Kato Katz microscopy with determination of egg load). Salmonella Typhimurium and Enteritidis isolates were assessed for genetic similarity with blood culture isolates obtained during the same period in a neighboring hospital using multi-locus variable-numbers tandem repeat analysis (MLVA). RESULTS: A total of 1,108 participants were included (median age 15 years (IQR: 7-36), male-to-female ratio of 1:1.1). The overall prevalence of Schistosoma mansoni infection and non-typhoidal Salmonella carriage was 51.2% (95% CI: 48.2-54.1) and 3.4% (95% CI: 2.5-4.7) respectively, with 2.2% (95% CI: 1.5-3.2) of participants coinfected. The proportion of Salmonella carriage tended to be higher among Schistosoma mansoni infected participants compared to non-infected participants but this difference did not reach statistical significance (4.2% versus 2.6%, p = 0.132). However, the proportion of Salmonella carriage among participants with a heavy Schistosoma mansoni infection was significantly higher compared to those with a light and moderate infection (8.7% versus 3.2%, p = 0.012) and compared to Schistosoma mansoni negatives (8.7% versus 2.6%, p = 0.002). The 38 Salmonella isolates comprised five and four Enteritidis and Typhimurium serotypes respectively, the majority of them had MLVA types identical or similar to those observed among blood culture isolates. CONCLUSION: Salmonella intestinal carriage was associated with a heavy intensity of Schistosoma mansoni infection. Further studies are needed to address causation.

BACKGROUND: Clinical observations and animal studies have suggested that Salmonella intestinal carriage is promoted by concurrent Schistosoma infection. The present study assessed association of Salmonella intestinal carriage and Schistosoma mansoni infection among individuals in a Schistosoma endemic area in sub-Saharan Africa. METHODS: From November 2015 to March 2016, a cross-sectional community-wide study was conducted in Kifua II, a rural village in Kongo Central Province, Democratic Republic of Congo. Stool samples were collected and analyzed for Salmonella intestinal carriage (culture) and Schistosoma mansoni infection (Kato Katz microscopy with determination of egg load). Salmonella Typhimurium and Enteritidis isolates were assessed for genetic similarity with blood culture isolates obtained during the same period in a neighboring hospital using multi-locus variable-numbers tandem repeat analysis (MLVA). RESULTS: A total of 1,108 participants were included (median age 15 years (IQR: 7-36), male-to-female ratio of 1:1.1). The overall prevalence of Schistosoma mansoni infection and non-typhoidal Salmonella carriage was 51.2% (95% CI: 48.2-54.1) and 3.4% (95% CI: 2.5-4.7) respectively, with 2.2% (95% CI: 1.5-3.2) of participants coinfected. The proportion of Salmonella carriage tended to be higher among Schistosoma mansoni infected participants compared to non-infected participants but this difference did not reach statistical significance (4.2% versus 2.6%, p = 0.132). However, the proportion of Salmonella carriage among participants with a heavy Schistosoma mansoni infection was significantly higher compared to those with a light and moderate infection (8.7% versus 3.2%, p = 0.012) and compared to Schistosoma mansoni negatives (8.7% versus 2.6%, p = 0.002). The 38 Salmonella isolates comprised five and four Enteritidis and Typhimurium serotypes respectively, the majority of them had MLVA types identical or similar to those observed among blood culture isolates. CONCLUSION: Salmonella intestinal carriage was associated with a heavy intensity of Schistosoma mansoni infection. Further studies are needed to address causation.