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Impact of the Decentralization and Integration of Control Activities in Basic Health Services

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Impact of the Decentralization and Integration of Control Activities in Basic Health Services Faculty of Medicine and Health Department of Public Health Sciences Contribution to the improvement of the control of Buruli ulcer in the Territory of Songololo: Impact of the decentralization and integration of control activities in basic health services Dissertation submitted for the degree of Doctor in Medical Sciences at the University of Antwerp to be defended by Delphin Phanzu Mavinga PROMOTERS Prof. Dr. Marleen Boelaert, ITM Prof. Dr. Greet Ieven, UA Prof. Dr. Pascal Lutumba Tshindele, UNIKIN MENTOR Em. Prof. Dr. Françoise Portaels Antwerp, 2015 ISBN: 9789057284809 Legal deposit number: D/2015/12.293/9 Contribution à l’amélioration du contrôle de l’Ulcère de Buruli dans le Territoire de Songololo : Impact de la décentralisation et de l’intégration des activités de lutte dans les services de santé de base *** Bijdrage aan het verbeteren van de bestrijding van Buruli ulcus in het gebied Songololo. Impact van de decentralisatie en integratie van de ziektebestrijding in de basisgezondheidsdiensten. Delphin Phanzu Mavinga Doctoral committee Chair Prof. Dr. Jean-Pierre Van geertruyden University of Antwerp, Belgium Promoters Prof. Dr. Marleen Boelaert Institute of Tropical Medicine, Belgium Prof. Dr. Greet Ieven University of Antwerp, Belgium Prof. Dr. Pascal Lutumba University of Kinshasa, DR Congo Institut National de Recherche Biomédicale, DR Congo Mentor Em. Prof. Dr Françoise Portaels Institute of Tropical Medicine, Belgium Member Prof. Dr. Lut Lynen Institute of Tropical Medicine, Belgium External jury members Prof. Dr. Tjip S. van der Werf University of Groningen, Netherlands Em. Prof. Dr. Jacques Aubry University of Nantes, France This study was supported by a PhD grant of the Institute of Tropical Medicine (ITM) supported by the Belgian Development Cooperation (DGD) in the frame of institutional cooperation. Dédicace A ma chère Patrie, Ab imo pectore Don béni de Dieu nous légué par nos aïeux Languis tout en nous n’est plus que ténébreux Retroussons nos manches afin que tous à l’ouvrage Nous nacrions l’image ternie de cet indivis héritage Que vers le progrès tous nous tendions Bien en quête de nouveaux horizons Possible serait-il par des hommes tout autres Refaisant parure de ce paradis terrestre Extrait du recueil "Délices cachées" Delphin Phanzu Mavinga 19 mai 1992 A toi, Godelive, A vous, Albi-Priscilla, Jonathan-Raphaël, Arnaud-Goddel, Don-Parfait & Roselyne la grâce Phanzu, Trouvez ici l’expression de mon profond amour. Table des matières Table des matières ................................................................................................................................................. 9 Liste des abréviations .......................................................................................................................................... 11 Résumé ................................................................................................................................................................. 13 Samenvatting ....................................................................................................................................................... 17 CHAPITRE I. INTRODUCTION GENERALE .............................................................................................. 21 I.1. DÉFINITION ................................................................................................................................................. 23 I.2. DESCRIPTION CLINIQUE DE L’UB ................................................................................................................ 23 I.3. EPIDÉMIOLOGIE .......................................................................................................................................... 25 I.4. DIAGNOSTIC ................................................................................................................................................ 30 I.5. TRAITEMENT ............................................................................................................................................... 34 I.6 CONTRÔLE DE LA MALADIE .......................................................................................................................... 35 I.7. BREF APERÇU HISTORIQUE DE L’ UB EN RDC............................................................................................. 40 I.8. RÉFÉRENCES ............................................................................................................................................... 41 CHAPITRE II. OBJECTIFS ET ORGANISATION DE LA THESE ........................................................... 59 II.1. ENONCÉ DU PROBLÈME DE RECHERCHE ..................................................................................................... 61 II.2. JUSTIFICATION DE LA THÈSE ...................................................................................................................... 62 II.3. OBJECTIF GÉNÉRAL .................................................................................................................................... 63 II.4. OBJECTIFS SPÉCIFIQUES ............................................................................................................................. 63 CHAPITRE III. METHODOLOGIE ................................................................................................................ 65 III.1. LA RÉPUBLIQUE DÉMOCRATIQUE DU CONGO .......................................................................................... 67 III.2. CADRE DU TRAVAIL ................................................................................................................................. 70 III.3. TYPES D’ÉTUDES ...................................................................................................................................... 71 III.4. ECHANTILLONS ÉTUDIÉS .......................................................................................................................... 71 III.5. DÉFINITIONS DE CAS ................................................................................................................................. 72 III.6. PROCÉDURES DE CONFIRMATION PAR LE LABORATOIRE ........................................................................... 73 III.7. COLLECTE DES DONNÉES .......................................................................................................................... 74 III. 8. ANALYSE DES DONNÉES .......................................................................................................................... 74 III. 9. ASPECTS ÉTHIQUES .................................................................................................................................. 75 CHAPITRE IV. RESULTATS .......................................................................................................................... 77 IV.1. PARTIE CLINIQUE ..................................................................................................................................... 79 IV.1.1. Mycobacterium ulcerans disease (Buruli ulcer) in a rural hospital in Bas-Congo, Democratic Republic of Congo, 2002-2004. 81 IV.1.2. Short report: edematous Mycobacterium ulcerans infection (Buruli ulcer) on the face: a case report 97 IV.1.3. Short Report: Under treated necrotizing fasciitis masquerading as ulcerated edematous Mycobacterium ulcerans infection (Buruli ulcer). 109 IV.1.4. Mycobacterium ulcerans infection (Buruli ulcer) on the face: a comparative analysis of 13 clinically suspected cases from the Democratic Republic of Congo 123 IV.2. PARTIE SANTÉ PUBLIQUE 145 IV.2.1. Effect of a control project on clinical profiles and outcomes in Buruli ulcer: a before/after study in Bas-Congo, Democratic Republic of Congo. 147 IV.2.2. Burden of Mycobacterium ulcerans disease (Buruli ulcer) and underreporting ratio in the Territory of Songololo, Democratic Republic of Congo 167 IV.2.3. Effectiveness of routine BCG vaccination on Buruli Ulcer Disease: a case-control study in the DR Congo, Ghana and Togo 195 IV.2.4. Management of Mycobacterium ulcerans disease (Buruli ulcer) in the Territory of Songololo, Democratic Republic of Congo: Outcomes, Challenges and Prospects. 231 CHAPITRE V. DISCUSSION GENERALE .................................................................................................. 253 CHAPITRE VI. CONCLUSION ET PERSPECTIVES D’AVENIR ........................................................... 275 REMERCIEMENTS ........................................................................................................................................ 281 CURRICULUM VITAE ................................................................................................................................... 285 10 Liste des abréviations AAF Aspiration à l’Aiguille Fine AFIP Armed Forces Institute of Pathology/Washington DC ALM American Leprosy Missions AS Aire de Santé BAAR Bacilles Acido-Alcoolo Résistants CHU Centre Hospitalier Universitaire CP-LT Coordination Provinciale Lèpre-Tuberculose CS Centre de Santé CSDT Centre de Santé de Dépistage et de Traitement CSR Centre de Santé de Référence CUL Culture sur milieu de Löwenstein CZN Coloration de Ziehl-Neelsen HGR Hôpital Général de Référence HIS Examen Histopathologique IEC Information, Education, Communication IME Institut Médical Evangélique de Kimpese IMT Institut de Médecine Tropicale d’Anvers IMUB Initiative Mondiale de lutte contre l’Ulcère de Buruli INRB Institut National de Recherche
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