Epidemiology and treatment of malaria in Kinshasa,

Democratic Republic of the Congo

INAUGURALDISSERATION

zur

Erlangung der Wrde eines Doktors der Philosophie

vorgelegt der

Philosophisch-Naturwissenschaftlichen Fakultt

der Universitt Basel

von

Giovanfrancesco Ferrari

von Como, Italien

Basel, 2016

Original document stored on the publication server of the University of Basel edoc.unibas.ch

This work is licensed under a Creative Commons Attribution 4.0 International License.

http://edoc.unibas.ch/http://creativecommons.org/licenses/by/4.0/

Genehmigt von der Philosophisch-Naturwissenschaftlichen Fakultt auf Antrag von Prof. Dr

Christian Lengeler und Dr. Umberto DAlessandro

Basel, den 23 Juni 2015

Prof. Dr. Jrg Schibler

The Dean of Faculty

To my family

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Table of contents

List of figures III

List of tables IV

List of abbreviations V

Acknowledgements VII

Summary IX

Rsum XIV

1. Introduction ................................................................................................................ 1

1.1 Global malaria distribution .......................................................................................... 1

1.2 Malaria disease and transmission ................................................................................. 2

1.3 The Anopheles vector ................................................................................................... 3

1.4 Epidemiological measures of malaria risk ................................................................... 3

1.5 Vector control measures ............................................................................................... 4

1.6 Mapping malaria risk ................................................................................................... 5

1.7 A brief overview of the Democratic Republic of the Congo and its administrative and health system organisation ........................................................................................... 6

1.8 Epidemiological situation and parasite distribution in the Democratic Republic of the

Congo ........................................................................................................................... 8

1.9 Malaria control interventions in the Democratic Republic of the Congo .................... 9

1.10 Urbanisation and health ............................................................................................. 11

1.11 Epidemiology of urban malaria .................................................................................. 11

1.12 Anaemia ..................................................................................................................... 13

1.13 Urban malaria control in Kinshasa ............................................................................. 14

1.14 Epidemiology of severe malaria ................................................................................ 15

1.15 A new treatment of severe malaria ............................................................................ 16

1.16 Cost of severe malaria ................................................................................................ 16

2 Aims and objectives ................................................................................................. 17

3 A comprehensive malaria risk map in Kinshasa, Democratic Republic of Congo .................................................................................................................................... 19

3.1 Abstract ...................................................................................................................... 20

3.2 Background ................................................................................................................ 22

3.3 Method ....................................................................................................................... 23

3.4 Results ........................................................................................................................ 31

3.5 Discussion .................................................................................................................. 48

3.6 Conclusions ................................................................................................................ 51

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4 Identifying risk factors for Plasmodium infection and anaemia in Kinshasa,

Democratic Republic of Congo ............................................................................... 53

4.1 Abstract ...................................................................................................................... 54

4.2 Background ................................................................................................................ 56

4.3 Method ....................................................................................................................... 57

4.4 Results ........................................................................................................................ 59

4.5 Discussion .................................................................................................................. 68

4.6 Conclusions ................................................................................................................ 71

5 An operational comparative study of quinine and artesunate for the treatment of severe malaria in hospitals and health centres in the Democratic Republic of

Congo: The MATIAS study .................................................................................... 72

5.1 Abstract ...................................................................................................................... 73

5.2 Background ................................................................................................................ 75

5.3 Methods ...................................................................................................................... 76

5.4 Results ........................................................................................................................ 85

5.5 Discussion .................................................................................................................. 91

5.6 Conclusions ................................................................................................................ 94

6 Delayed anaemia after treatment with injectable artesunate in the Democratic Republic of Congo: a manageable issue ................................................................. 96

6.1 Abstract ...................................................................................................................... 97

7 Feasibility and acceptability of injectable artesunate for the treatment of severe malaria in the Democratic Republic of Congo .................................................... 103

7.1 Abstract .................................................................................................................... 104

7.2 Background .............................................................................................................. 106

7.3 Methods .................................................................................................................... 107

7.4 Results ...................................................................................................................... 112

7.5 Discussion ................................................................................................................ 118

8 General discussion and conclusions ...................................................................... 121

8.1 Prospects for future research on risk map data ........................................................ 122

8.2 Prospects for malaria control in Kinshasa ................................................................ 123

8.3 Prospects for the implementation of injectable artesunate in the DRC ................... 126

8.4 Challenges to the introduction of injectable artesunate in the DRC setting ............ 126

9 References ............................................................................................................... 130

10 Curriculum vitae .................................................................................................... 147

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List of figures

Figure 1-1: World malaria distribution in 2014 ......................................................................... 1