# Malaria epidemic outbreaks in the Democratic Republic of Congo, part I: cross-sectional survey in Mweka District

## TL;DR

This study investigated fever outbreaks in Mweka District, DR Congo, and found they were caused by a malaria epidemic with high child mortality.

## Contribution

The study confirms a malaria epidemic in Mweka District and highlights high mortality in children under five.

## Key findings

- Malaria cases exceeded expected numbers in the savannah and one forest zone health center (p<0.05).
- 82.2% of fever cases in 653 people were attributed to Plasmodium falciparum malaria.
- Anopheles gambiae mosquitoes in Mweka showed resistance to permethrin with low knockdown and mortality rates.

## Abstract

A series of outbreaks of fever has previously been reported in the DR Congo. The occurrence of similar outbreaks in Mweka district presented the opportunity to investigate these occurrences.

Health facilities and communities were visited. Permission was obtained to access to health records and a questionnaire was competed in the community. Blood samples for malaria, salmonellosis, Chikungunya, dengue and filovirus testing were obtained both in health facilities and the communities. Capture of mosquitoes and larvae in breeding sites was done and used bednets were collected. Excel, SPSS and Stats Direct were used for analyses of epidemiological data and malaria case management, with the Chi-square test and Fisher’s Exact test used for assessing relationships resulting from contingency table analyses.

An increase in the number of malaria cases beyond the expected number for the study period was observed in the two health districts located in the savannah zone (p<0.05) and in one health centre among sixteen located in the forest zone (p<0.05). In the health facilities and households visited (653 people), 141 persons had fever of which 82.2% was attributed to Plasmodium falciparum malaria. An incidence of 5.87% was recorded in the first half of 2013. Hundred and sixty patients (6.9%) died among 2,304 admitted for severe malaria in the three referral hospitals, 118 of them were children of under five years old. PCR testing of the blood samples obtained during home visits revealed malaria parasites in 63 (73.3%) of the 86 analysed samples. The test was negative for other parasites and bacteria and one dengue virus case was detected. Anopheles gambiae from Mweka were found to be resistant to permethrin using the WHO susceptibility test, with a knock down rate of ≤ 50% and mortality of ≤ 30%.

These investigations confirmed epidemic outbreaks in Mweka District caused by malaria with a high mortality rate in children below five years of age.