Pascal Lutumba

• MD, MSc, MPH, PhD
• University of Kinshasa

Background The declining effectiveness of Intermittent Preventive Treatment in pregnancy with sulfadoxine-pyrimethamine (IPTp-SP) due to the emergence of Plasmodium falciparum resistance highlights the need for alternative malaria prevention strategies in pregnant women. A novel approach was proposed: screening with an ultra-sensitive rapid diagnos...

Background Low peripheral parasitemia caused by sequestration of Plasmodium falciparum in the placenta hampers the diagnosis of malaria in pregnant women, leading to microscopy or conventional rapid diagnostic tests (co-RDTs) false-negative results. Although mainly asymptomatic, maternal malaria remains harmful to pregnant women and their offspring...

Despite continuous efforts to control schistosomiasis (SCH) in the Democratic Republic of the Congo (DRC), it still poses a significant challenge. In order to enhance control measures, additional research is necessary. This study documents the burden of SCH infection and its predictors in a rural area of the DRC. We conducted a household cross-sect...

Background Malaria morbidity and mortality increase in the Democratic Republic of the Congo (DRC) may be the consequence of the low utilization rate of long-lasting insecticidal nets (LLINs) resulting from poor compliance due to adverse events (AEs). This study aimed at determining the prevalence and predictors of AEs following the mass distributio...

Background The Democratic Republic of the Congo (DRC) is the second most malaria-affected country in the world with 21,608,681 cases reported in 2019. The Kongo Central (KC) Province has a malaria annual incidence of 163 cases/per 1000 inhabitants which are close to the national average of 153.4/1000. However, the malaria prevalence varies both bet...

Background Intermittent preventive treatment in pregnancy (IPTp) with sulfadoxine-pyrimethamine (SP) is an important malaria control strategy in sub-Saharan Africa. Indeed, it overcomes the risk of misdiagnosis due to low peripheral parasitemia during pregnancy by treating women with SP on predetermined schedules. However, over time, the spread of...

Detection of Schistosoma eggs in stool or urine is known for its low sensitivity in diagnosing light infections. Alternative diagnostics with better sensitivity while remaining highly specific, such as real-time PCR and circulating antigen detection, are progressively used as complementary diagnostic procedures but have not yet replaced microscopy....

Introduction The Democratic Republic of Congo (DRC) is the second most malaria-affected country globally with 21,608,681 cases reported in 2019. The Kongo Central (KC) Province has a malaria annual incidence of 163 cases/per 1000 inhabitants which are close to the national average of 153.4/1000. However, the malaria prevalence varies both between a...

Background: Democratic Republic of Congo has shifted from pan test to mono-specific malaria RDT tests. A new Histidine rich protein 2 (HRP2)-based Rapid Diagnostic Tests for malaria diagnosis was then implemented. Objective: This study evaluated the performances of this new diagnostic tool compared to the thick smear as the gold standard. Method: T...

Background The epidemiology of human cysticercosis and neurocysticercosis, caused by the larval stage of the pork tapeworm Taenia solium , is not well known in the Democratic Republic of Congo (DRC). Within a multicenter etiological and diagnostic study conducted by the NIDIAG consortium (“Better Diagnosis for Neglected Infections”) and investigati...

A high epilepsy prevalence has been reported in onchocerciasis meso- and hyper-endemic regions in sub-Saharan Africa, including in the Democratic Republic of Congo (DRC). We investigated whether onchocerciasis-associated epilepsy can also be suspected in onchocerciasis hypo-endemic regions. Stored serum samples from 342 patients admitted with recen...

Background The burden of malaria infection in sub-Saharan Africa among school-aged children aged 5–15 years is underappreciated and represents an important source of human-to-mosquito transmission of Plasmodium falciparum. Additional interventions are needed to control and eliminate malaria. We aimed to assess whether preventive treatment of malari...

Background The Democratic Republic of the Congo (DRC) accounts for the majority of the reported gambiense human African trypanosomiasis (HAT) cases. Kongo Central province in the DRC reports a relatively low, yet steady number of cases, and forms a transboundary focus with Angola and the Republic of Congo. This paper describes an intervention aimed...

Background Malaria is endemic in all regions where gambiense or rhodesiense human African trypanosomiasis (HAT) is reported, and both diseases have similarities in their symptomatology. A combined test could be useful for both diseases and would facilitate integration of the screening for gambiense HAT (gHAT) and malaria diagnosis. This study aimed...

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 Novemb...

Introduction: Quality of care is essential to save people living with different diseases. However, inappropriate diagnosis may in no case lead to proper patient management as well as to quality of care. We conducted a cross-sectional descriptive analysis in three laboratories at the General Hospitals in the Democratic Republic of the Congo. Metho...

Background The epidemiology of human cysticercosis and neurocysticercosis, caused by the larval stage of the pork tapeworm Taenia solium, is not well known in the Democratic Republic of Congo (DRC). As part of an etiological study, we consecutively evaluated from 2012 to 2016 all patients older than 5 years admitted for neurological disorders (neur...

Background The epidemiology of human cysticercosis and neurocysticercosis, caused by the larval stage of the pork tapeworm Taenia solium , is not well known in the Democratic Republic of Congo (DRC). As part of an etiological study, we consecutively evaluated from 2012 to 2016 all patients older than 5 years admitted for neurological disorders (neu...

Melarsoprol administration for the treatment of late-stage human African trypanosomiasis (HAT) is associated with the development of an unpredictable and badly characterized encephalopathic syndrome (ES), probably of immune origin, that kills approximately 50% of those affected. We investigated the characteristics and clinical risk factors for ES,...

Introduction Le paludisme grave est encore de nos jours un problème majeur de santé publique dans notre milieu. Sa morbidité et sa mortalité sont encore élevées surtout chez les enfants de moins de 5 ans. C'est dans la communauté que sont administrés les premiers soins et l'on n'y remarque souvent une attitude mitigée qui fait penser à une insuffis...

In low-resource hospitals of central Africa, neurological disorders are frequent and etiologies very diverse. The difficulty to identify invasive bacterial infections in this setting results in major antibiotic overuse. Biomarkers such as C-reactive protein (CRP) and procalcitonin (PCT) may help discriminate these conditions. We retrospectively det...

Introduction Artemisinin-based combination therapy is currently the best option for the treatment of uncomplicated malaria. Quinine is recommended as a rescue treatment. Safety information during repeated treatment with the same drug is scarce. We report safety data from the Quinact randomized clinical trial (RCT) that was designed to assess effica...

Background The World Health Organization (WHO) End Tuberculosis Strategy calls for a 90% reduction in tuberculosis (TB) deaths and an 80% reduction in the incidence rate between 2015 and 2035. The 2018 WHO guidelines recognize the need for high-burden countries to implement outreach and treatment for the most vulnerable patients with latent TB infe...

BACKGROUND: Pathogens causing acute fever, with the exception of malaria, remain largely unidentified in sub-Saharan Africa, given the local unavailability of diagnostic tests and the broad differential diagnosis. METHODOLOGY: We conducted a cross-sectional study including outpatient acute undifferentiated fever in both children and adults, betwee...

Background Pathogens causing acute fever, with the exception of malaria, remain largely unidentified in sub-Saharan Africa, given the local unavailability of diagnostic tests and the broad differential diagnosis. Methodology We conducted a cross-sectional study including outpatient acute undifferentiated fever in both children and adults, between...

Human African trypanosomiasis (HAT) also known as sleeping sickness is targeted for elimination as a public health problem by 2020 and elimination of infection by 2030. Although the number of reported cases is decreasing globally, integration of HAT control activities into primary health services is endorsed to expand surveillance and control. Howe...

Diarrheal diseases are one of the leading causes of death among children younger than 5 years of age in the world in general and in sub-Saharan Africa in particular. Mothers are predominantly responsible for child care and housekeeping in this region. The objective of this study was to determine the prevalence of diarrhea and identify its maternal...

Introduction The integration of human African trypanosomiasis (HAT) activities into primary health services is gaining importance as a result of the decreasing incidence of HAT and the ongoing developments of new screening and diagnostic tools. In the Democratic Republic of Congo, this integration process faces multiple challenges. We initiated an...

During the last 30 years, investigations on the microbiome of different tsetse species have generated substantial data on the bacterial flora of these cyclical vectors of African trypanosomes, with the overarching goal of improving the control of trypanosomiases. It is in this context that the presence of Wolbachia and Sodalis glossinidius was stud...

Human African trypanosomiasis is close to elimination in several countries in sub-Saharan Africa. The diagnosis and treatment is currently rapidly being integrated into first-line health services. We aimed to document the perspective of stakeholders on this integration process. We conducted 12 focus groups with communities in three health zones of...

Introduction Schistosomiasis (SCH) is an important public health problem in developing countries and school-aged children are the most affected. This study explored health and nutritional status and their correlation with SCH in children attending primary school (3rd to 6th class) living in the area of Kasansa in the Democratic Republic of Congo....

Human African Trypanosomiasis (HAT) is a parasitic vectorborne disease that remains a major problem in Sub-Saharan Africa. WHO's goal is the elimination of HAT as a public health problem by 2020. Current control and surveillance activities include case finding, treatment, and tsetse control. A more intense deployment of the right mix of strategies...

New rapid diagnostic tests (RDTs) for screening human African trypanosomiasis (HAT) have been introduced as alternatives to the card agglutination test for trypanosomiasis (CATT). One brand of RDT, the SD BIOLINE HAT RDT has been shown to have lower specificity but higher sensitivity than CATT, so to make a rational choice between screening strateg...

Cost and parameter derivation. This file gives details of the calculation of costs and parameters used in this study. (DOC)

Introduction: Despite multiple efforts, malaria remains an urgent and deadly disease in the Democratic Republic of Congo. We analyzed incidence trends over eight years in the health district of Lubumbashi. Methods: We conducted an observational study based on annual data from PNLP / Haut-Katanga from January 2007 to December 2014. The analysis of t...

Analysis of cerebrospinal fluid (CSF) obtained by lumbar puncture (LP) is an essential step for the diagnostic approach of neurological disorders, in particular neuro-infections. In low-resource settings, it is even often the only available diagnostic method. Despite its key contribution, little is known on the risks and benefits of LP in the large...

Introduction: malaria is still a major public health concern in the Democratic Republic of Congo. Its morbidity and mortality challenge the actual strategies of the fight agains malaria. This study was aimed to describe the epidemiology, the clinical caracteristics and the risk factors of death associated to severe malaria in the pediatric populati...

Background The emergence of resistance against artemisinin combination treatment is a major concern for malaria control. ACTs are recommended as the rescue treatment, however, there is limited evidence as to whether treatment and re-treatment with ACTs select for drug-resistant P. falciparum parasites. Thus, the purpose of the present study is to i...

Cumulative risk of crude treatment failure (PCR-unadjusted) by Pfmdr1 in patients treated with AL and ASAQ in the randomisation phase. Figure A1-A3 represent the risk of crude treatment failure in patents who received AL by Pfmdr1 variants. Figure B1-B3 represents the risk of crude treatment failure in participants who received ASAQ by Pfmdr1 varia...

Multivariate logistic regression model of the association between Pfmdr1 SNPs and PCR-corrected recrudescence and new infections of patients treated with AL and ASAQ on day 28 follow-up in RCT phase. (DOCX)

Background: In 2012, the World Health Organization recommended blocking the transmission of Plasmodium falciparum with single low-dose primaquine (SLDPQ, target dose 0.25 mg base/kg body weight), without testing for glucose-6-phosphate dehydrogenase deficiency (G6PDd), when treating patients with uncomplicated falciparum malaria. We sought to deve...

Objectives: To estimate the diagnostic accuracy of HAT Sero K-SeT for the field diagnosis of second-stage human African trypanosomiasis (HAT). Design: A phase III diagnostic accuracy design. Consecutive patients with symptoms clinically suggestive of HAT were prospectively enrolled. We compared results of the index test HAT Sero K-SeT with those...

Background: Rotavirus infection is responsible of 20 to 70% hospital admissions and between 6000,000 to 2 million of deaths per year in developing countries. A number of circulating genotypes are different from one geographical zone to another compromising the possibility of having a vaccine with equal efficacy. Thus, characterizing circulating gen...

Introduction: In DRC, Malaria remains a major public health problem where the morbidity and mortality challenges the current malaria control strategies. This study aimed to identify the epidemiology, the clinical features and the risk factors of lethality of severe malaria in pediatrics’ population of this hospital. Methods: This retrospective cro...

There is little published information on the epidemiology of neurological disorders in rural Central Africa, although the burden is considered to be substantial. This study aimed to investigate the pattern, etiology, and outcome of neurological disorders in children > 5 years and adults admitted to the rural hospital of Mosango, province of Kwilu,...

Objective: To determine the prevalence of schistosomiasis (SCH) and soil-transmitted helminths (STH) in the Democratic Republic of Congo, and to assess the capacity of the local health centers for diagnosis and treatment. Methods: Cross-sectional school-based survey in two Health Districts in the province of Kwilu. We collected a stool and a uri...

We carried out a study to compare the performance, in terms of sensitivity and specificity, of the new SD BIOLINE® HAT rapid diagnostic test (RDT) with the card agglutination test for trypanosomiasis (CATT) for diagnosis of human African trypanosomiasis (HAT) in the Democratic Republic of the Congo (DRC). Participants were enrolled actively by four...

Helminth co-infections are common in sub-Saharan Africa. However, little is known about the distribution and determinants of co-infections with Taenia solium taeniasis/cysticercosis. Building on a previous community-based study on human cysticercosis in Malanga village, we investigated co-infections with Taenia solium, soil-transmitted helminths (S...

Sulphadoxine/pyrimethamine (SP) is still used for malaria control in sub-Saharan Africa; however, widespread resistance is a major concern. This study aimed to determine the dispersal and origin of sulphadoxine resistance lineages in the Democratic Republic of the Congo compared with East African Plasmodium falciparum dihydropteroate synthetase (Pf...

Background The Good Clinical Practices (GCP) codes of the World Health Organization and the International Conference of Harmonization set international standards for clinical research. But critics argue that they were written without considering the challenges faced by clinical researchers in low- and middle-income countries (LMIC). Methods We ana...

Background The emergence of resistance against artemisinin combination treatment (ACTs) is a major concern for malaria control. ACTs are recommended as rescue treatment; however, there is limited evidence on the impact of treatment and re-treatment with ACTs on selection for drug-resistant parasites. We aimed to investigate the impact of treatment...

Objective: To improve knowledge and practice of health staff as well as the availability of material resources for diagnosis and management of schistosomiasis in two endemic provinces of DRC (Kinshasa and Bas-Congo). Methods: Structured interviews were performed using questionnaires with staff from 35 healthcare facilities in 9 health zones (HZ) of...

In endemic areas, malaria and its adverse effects in schoolchildren may be prevented by intermittent preventive treatment (IPTsc). However, the most appropriate drug regimen for IPTsc remains to be identified. A randomised controlled trial was conducted in Kinshasa, DRC. Enrolled schoolchildren were assigned to a passive control arm (n = 212), sulf...

Background Intermittent preventive treatment (IPT) is likely to be the most promising therapeutic strategy to prevent malaria and its related adverse outcomes in schoolchildren. However, its successful implementation will depend on acceptability to key stakeholders such as parents and teachers. Methods A qualitative research was conducted, followi...

The Good Clinical Practices (GCP) codes of the WHO and the International Conference of Harmonization set international standards for clinical research. But critics argue that they were written without consideration for the challenges faced in low and middle income countries (LMICs). Based on our field experience in LMICs, we developed a non-exhaust...

In resource-limited settings, the scarcity of skilled personnel and adequate laboratory facilities makes the differential diagnosis of fevers complex [1–5]. Febrile illnesses are diagnosed clinically in most rural centers, and both Rapid Diagnostic Tests (RDTs) and clinical algorithms can be valuable aids to health workers and facilitate therapeuti...

For a clinical study in the European research network on better diagnosis for neglected infectious diseases (NIDIAG) project (Better Diagnosis of Neglected Infectious Diseases: www.nidiag.org), we developed Standard Operating Procedures (SOPs), which we implemented in a basically equipped laboratory in a 380-bed rural hospital (“Hopital General de...

Job aid on the specimen types to be collected during the study. This job aid represents a table summarizing the NIDIAG study specimen numbering information extracted from SOP-WP6-DOC-02-V02.1-18Sep2012, and was put as its annex five. The job aid has a clear title linking it to an approved SOP, thus making it subject to document control. Font type C...

SOP Manual—Neurological Syndrome. Set of 50 SOPs used for the NIDIAG study on neurological disorders. (PDF)

Overview of the laboratory QMS and other documents assessed for the writing and implementation of SOPs. (PDF)

Example of a NIDIAG SOP using the NIDIAG SOP template, indicating some important characteristics. (PDF)

Extract of SOP-WP2-LAB-35-V2.0-11Apr2014 on how to perform the SD Bioline Malaria Ag PF/Pan RDT (SD 05FK60), showing the interpretation section. Clear drawings, a flowchart, and a decision table are used. The SOP is based on the generic WHO job aid of a malaria RDT (http://www.who.int/malaria/areas/diagnosis/rapid-diagnostic-tests/generic_PfPan_tra...

Overview of the standard operating procedures (SOPs) used in the NIDIAG febrile syndrome study. (DOCX)

Set of SOPs used in the NIDIAG persistent fever syndrome study. (PDF)

To eliminate and eradicate gambiense human African trypanosomiasis (HAT), maximizing the effectiveness of active case finding is of key importance. The progression of the epidemic is largely influenced by the planning of these operations. This paper introduces and analyzes five models for predicting HAT prevalence in a given village based on past o...

Background In the Democratic Republic of Congo, artesunate-amodiaquine (ASAQ) is the first-line medication recommended for uncomplicated malaria treatment. We conducted a study in Kinshasa to describe the clinical features of the disease and assess the efficacy of ASAQ and its impact on the multiplicity of infection in children with uncomplicated m...

(PDF)

Quinact protocol. (PDF)

Quinact protocol published in Trials Journal. (PDF)

Introduction: in sub-Saharan Africa, the proportion of persons with epilepsy who seek traditional treatment is estimated at 80%. Despite that children are the firsts concerned by epilepsy, the characteristics and particularities of the children with epilepsy (CWE) who resort to traditional treatment are not known. The aim of this pilot study was to...

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 s...

Background Sleeping sickness (human African trypanosomiasis [HAT]) is caused by protozoan parasites and characterized by a chronic progressive course, which may last up to several years before death. We conducted two Phase 2 studies to determine the efficacy and safety of oral pafuramidine in African patients with first stage HAT. Methods The Phas...

CONSORT checklist. (DOC)

The present External Quality Assessment (EQA) assessed microscopy of blood parasites among diagnostic laboratories in the Democratic Republic of the Congo. The EQA addressed 445 participants in 10/11 provinces (October 2013-April 2014). Participants were sent a panel of five slides and asked to return a routinely stained slide which was assessed fo...

Human African trypanosomiasis (HAT) found only in sub-Saharan Africa is caused by the parasite Trypanosoma brucei which is transmitted by tsetse flies. Only two subspecies of T.brucei are pathogenic for humans: T.b. gambiense and T.b. rhodesiense. HAT is endemic in 36 sub-Saharan countries, and 98 % of all reported HAT cases are due to T. b. gambie...

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 co...

The diagnosis of malaria, caused by Plasmodium spp., still remains a challenging process. Especially in low-income countries, a rapid user-friendly method is needed for the efficient care of the patient. A small-angle light scattering device consisting of hardware and software was developed. Using the DNA-binding dye SYBR Green, malaria infections...

In medical research, the ethical principle of respect for persons is operationalized into the process of informed consent. The consent tools should be contextualized and adapted to the different socio-cultural environment, especially when research crosses the traditional boundaries and reaches poor communities. We look at the challenges experienced...

Background Anaemia reduces cognitive potential in school children, retards their growth and predisposes them to other diseases. As there is a paucity of data on the current burden of P. falciparum, S. mansoni and soil transmitted helminths (STH) infections and their correlation with schoolchildren’s anemia in the Democratic Republic of Congo (DRC),...

Background In malaria endemic areas, asymptomatic malaria infection causes anemia, malnutrition and reduces cognitive abilities in schoolchildren. Intermittent preventive treatment (IPT) may be a suitable strategy to prevent malaria and its adverse effects in this specific group. The most appropriate drug regimen for IPT needs to be identified. Metho...

Background Artemisinin-based combination treatments (ACTs) are recommended for 1st line treatment in uncomplicated malaria. Quinine + clindamycine (QnC) or another ACT is recommended as rescue treatment. In field circumstances, patients are often re-treated with the same antimalarial drug, with unclear evidence on the outcome and long term consequen...

Background In the Democratic Republic of Congo, artesunate-amodiaquine (ASAQ) and artemether-lumefantrine (AL) are recommended as first line treatment, but ASAQ is commonly used. We describe malaria features in Kinshasa and also constitute a cohort for a randomized clinical trial (RCT) to assess efficacy of ASAQ, AL and quinine + clindamycin as rescu...