부산대학교 도서관

Gambiense Human African Trypanosomiasis (g-HAT) is a neglected tropical disease caused by trypanosomes transmitted by tsetse flies. 70% of cases in 2019 (604/863) occurred in the Democratic Republic of Congo (DRC). The national programme for g-HAT elimination in DRC includes a large-scale deployment of Tiny Targets which attract and kill tsetse. This intervention is directed by vector-control specialists with small teams, moving in canoes, deploying Tiny Targets along riverbanks where tsetse concentrate. While the targets are deployed in communal areas, and the method is cheap and easy-to-use, local people have little involvement. This study aimed to evaluate if a community-led vector control programme was feasible in the context of DRC's g-HAT elimination programme. In 2017, a community-led intervention was implemented in three villages in the Kwilu province of DRC. This intervention was evaluated through an Action Research with qualitative data collected through 21 focus group discussions and 289 hours of observation. Also the geographical location and quality of each Tiny Targets were collected (total number deployed = 2429). This research revealed that community-based approach largely worked: people were motivated and proactive, showed a good application of the acquired knowledge resulting in an effective deployment of Tiny Targets. In addition, our study provided evidence that acceptability of the targets by the community can improve deployment quality by reducing target loss and damage. The approach was feasible in places where canoe-based teams could not reach. Against these advantages, a community-based approach was time-consuming and had to adapt to the seasonal and daily rhythms of the community. A community-based approach for tsetse control is technically feasible and recommended but limits to the speed and scale of the approach restraints its application as a standalone strategy in a large-scale national programme aiming to eliminate g-HAT in a short timeframe. Author summary: Sleeping sickness (Human African Trypanosomiasis, HAT) is a neglected disease caused by Trypanosoma brucei gambiense or T.b.rhodesiense both transmitted by tsetse flies. Currently 70% of the global cases of Gambiense HAT (g-HAT) occur in Democratic Republic of Congo (DRC). Over the last 20 years, a national programme of screening and treating humans has driven down the number of cases of g-HAT from >30,000 to <2,000 cases/year. However, epidemiological models suggest that the complete elimination of g-HAT across DRC requires the addition of vector control. Accordingly, in 2016 large-scale deployment of Tiny Targets which attract and kill tsetse, was adopted as part of the national strategy to eliminate g-HAT. Targets are deployed by canoe-based teams directed and managed by vector control specialists. Using an Action-Research approach and qualitative methods, we assessed whether local communities in three villages could play a greater role. We found that Tiny Targets were well accepted by local people who deployed targets effectively, but the speed and scale of the deployment was limited by the underlying movement of local people and the rhythms of their life. We conclude that a community-based approach is feasible but not as a standalone large-scale programme in DRC. [ABSTRACT FROM AUTHOR]